How Early Is Too Early for a Girl to Enter Puberty?
Even in many cases in which a girl under 6 shows signs of puberty, there may be no problem, says Kaplowitz. "It's not at all rare to see children 3 and under with breast development. The majority of the time, it's a normal variant ... different from precocious puberty because it doesn't progress rapidly. Growth is normal, and bone maturation does not advance," he says.
But for some girls, like Jasmine, these signs can signal a hormonal imbalance, says her doctor, John Parks, MD, a pediatric endocrinologist at Emory University School of Medicine in Atlanta. Too much estrogen produced by the ovaries triggers rapid increases in breast development, bone growth, weight gain, appetite -- and menstruation follows a few years later.
The current treatment for precocious puberty involves monthly injections of hormone-like substances (one is marketed as Lupron) that suppress the reproductive hormones. "Hormone therapy will stop the progression of breast development," Parks tells WebMD. "It also slows height and weight increases, and the progression of skeletal maturation."
If precocious puberty is not treated, a child could find herself in the throes of emotions and physical changes more typical of teens, Parks tells WebMD. And ultimately, her bone development -- and adult height -- could be affected.
"Early puberty leads to early growth, so that a child tends to be tall relative to their peers," Parks says. "These children will complete their growth early, so they wind up taller than peers in first through fourth grades. Then, they stop growing and wind up shorter than you would expect from family background."
Children who are well into puberty before their age 6 birthdays will benefit from hormonal treatments in terms of their adult height, Parks tells WebMD. "If puberty appears later, or intervention is later, the height issues become a little more cloudy. Most of those children attain quite a normal adult height. The loss might be 1 or 2 inches [from] what you would expect from parents' heights.
"But it's the very, very early developers who stand to lose more with untreated early puberty," he says. "The younger they are, the more they stand to benefit in terms of improvement in adult height."
Jasmine's growth was relatively slow until the past year, so her parents opted to hold off treatments for a while, her mother says. "We didn't want to subject her to monthly injections that could last from her fourth to her 10th birthday -- six years," she says. She's just had her seventh birthday -- and her first injection. Not a fun experience, her mother says. "She's still a little girl. ... She hates needles," she says.
Kaplowitz says that some doctors are overprescribing Lupron to appease anxious parents. "Lupron is wonderful for 4-, 5- and 6-year-olds who are maturing very rapidly," he tells WebMD. "But there are a lot of kids who are 7 to 8 years of age who are receiving this drug and would probably do just fine without it. The drug costs $6,000-10,000 a year, plus you have doctor visits for the monthly injections. Plus, there are visits to the endocrinologist every three months."